Produce an integrative case study which
demonstrates your ability to assess, plan, intervene and evaluate.
Introduction
The main body of this essay
will pursue the four stages of Chapman and Hough’s effective practice cycle
(1998) with regards to the assessing and addressing of a specific offenders
behaviour. These four stages consist of the following; assessment, planning,
intervention and evaluation, and form a continuous process that allows for
constant evaluation and further implementation of change if required. Running
throughout this structure will be a live practice example, which in theory will
assist in the demonstration of how my personal knowledge, skills and practice
have developed over the duration of this specified intervention. This in turn
will of course inform my practice on a holistic level. A further constant
within this piece of reflective analysis is the use of that very term,
reflection. This allows the author to critically reflect on this piece of
practice, whilst charting the effect of my personal beliefs and values, and how
they impact on practice. However before moving through the cycle it is
important to highlight the organisational context in which practice occurs.
In 1998 a key report was published by HMIP, entitled ‘Strategies for Effective Offender Supervision,’ which essentially summarised the findings of the What Works movement. This publication included a working definition…
“Effective practice produces the intended results – the pursuit of effectiveness lies at the heart
of the contract that Probation Services
enter into.”
This model of practice
therefore works on the premise that ‘some
things work for some people some of the time,’ and that through
standardisation and the use of techniques that ‘work’ the Probation Service can
achieve its goals and objectives. This is further supported by the emergence of
National Standards (NS), which ‘set the
standards to which local Probation boards should ensure offenders are
supervised and services provided.’ (National Standards 2002). NS therefore
offer an underpinning framework for all Probation practice, and in the context
of this essay it guides and informs not only this example of supervision, but
the entirety of my professional practice.
The case that will be
referred to throughout is that of MM, whom I have case managed from October
XXXX. MM is a white male who was originally sentenced to a one year
Community Rehabilitation Order (CRO) for an offence of Racially Aggravated
Threats. However three months into the Order he subsequently re-offended
(Harassment) and was sentenced to a two year CRO with attachments of Enhanced
Thinking Skills (ETS) and Addressing Substance Related Offending (ASRO)
programmes. The salient points surrounding this individual are his diagnosed
schizophrenia and alcohol dependence. However his chaotic lifestyle, complex
family history, discriminatory attitudes, social isolation and low self esteem
added to the overall complexities of the case. With reference to the relevant
legislation surrounding the sentence, his CRO was made under Section 41 of the
Courts (services) Act 2000. The policy framework for the supervision and
enforcement of this Community Order are highlighted within the latest revision
of NS 2005. This essay will pay particular attention to the supervision
sessions involving the offender and supervisor during a twenty two week period.
Whilst I do not plan to detail the entirety of each individual contact I would
wish to concentrate on his assessment as PSR Stage, completed by myself, the
prevailing weeks and of course his most recent contacts. This will enable the
detailing of each of the cycles stages, a review of my personal development in
relation to practice and how I have learned from mistakes that I have made and
perhaps identify things I could do better in future practice.
Assessment
The assessment stage is
crucial in terms of informing and directing the remainder of the process, that
is it’s a dynamic feature that continues to inform. According to Chapman and
Hough (1998) assessment allows the practitioner to ‘ascertain the level and type of risk posed by, and the criminogenic
needs of, an individual offender.’ On this premise therefore the primary
dimensions of assessment are ‘risk and community integration.’ This idea is
reiterated in the Home Office publication ‘A New Choreography’ (2001) which
expresses the need for a ‘unique offender
profile to be gained from both actuarial and dynamic risk and needs assessment
[which] must become the expectation in every Probation report and supervision
case.’ This initial assessment usually takes place at the first point of
contact between the offender and Service, primarily through the Courts request
for a Pre Sentence Report (PSR) or Fast Delivery Report (FDR). In the case of
MM the former was requested in relation to a Harassment Offence, yet given the
need for a psychiatric report an Addendum was also completed, outlining the
potential management of the specific risks within a community setting – namely
those of mental health and alcohol use.
According to Tuddenham
(2000) ‘Public protection and risk
assessment are central to everything we do.’ The assessment of risk
therefore must be the primary element of assessment procedure, yet in assessing
this ‘risk’ one must be well acquainted with the many dimensions associated
with it. For Chapman and Hough (1998) risks relate to the actual and perceived
threat that the offender poses to the safety and property of potential
victims.’ On this basis a risk assessment aims to identify both the likelihood
of an offender re-offending and the potential level of harm they may pose to
others and themselves. Essentially we as practitioners have a set of clinical
and actuarial approaches which utilize both static and dynamic factors
associated with an individual offender..
With regard to MM’s risk my
primary task was to complete an actuarial risk assessment (OGRS) based purely
on static factors such as age, pre-convictions etc. This allows the
practitioner to calculate the likelihood of MM re-offending within a two year
period, although I have found it important to understand two key principles.
Primarily this tool is not a predictor, but rather a presentation of probabilities
in terms of the likelihood of re-offending. Secondly the importance of
accurately inputting statistical factors accurately is paramount – if incorrect
this could lead to a biased outcome and of course probable negative or even
positive discrimination. MM’s OGRS score (40%) suggests that the probability of
him being convicted for an offence over two years is moderate, yet developing
an understanding and appreciation of what this actually means has taken time.
As Kemshall states (1990) these assessment tools are’ formulated upon the knowledge of how others have responded in
similar circumstances, or from the offenders similarity to others that have
proved to be risky in the past.’
The primary clinical
assessment for assessing and addressing risk issues emerged in the 1990s from
the What Works movement. This type of assessment could record and identify
factors that were none static, or in other words dynamic. This tool is
currently known as e-OASys (electronic-offender assessment system), which
facilitates a detailed assessment of the dynamic risk factors, or criminogenic
needs, allowing the practitioner to make informed judgments on the levels of
risk in terms of re-offending, harm to self and others. Upon ascertaining these
factors and attempting to change them we are, according to Bonta (1996)
changing the ‘likelihood of criminal
behaviour, and thus criminogenic needs are actually risk predictors.’ When
reflecting upon MM’s assessment I am of the opinion that these criminogenic
factors were largely deficits/negatives – poor mental health, excessive alcohol
use, discriminatory attitudes, unemployment and inappropriate accommodation.
However what I did not
investigate throughout this assessment were the positives and/or strengths that
he possesses – his academic qualification, long term abstinence from heroin,
strong links with some family members are to name but a few. On this basis this was an inaccurate
assessment in which I found myself fully exploring the problems but not the
positives in his life. This type of
assessment approach is effectively biased, and therefore potentially inaccurate
in assessing risk. Moore (1996) identifies four areas of potential bias –
atributional, representativeness, confirmation and perhaps most relevant to my
assessment, selectivity bias. Of course it is acknowledged that a combined use
of clinical and actuarial tools enable uniformity and consistency, yet critics
(De Shazer 1998) feel that they concentrate too much on the problem, or that
they focus more upon risks of reconviction and criminogenic needs rather than
risks to self and others. (Tuddenham 2000).
This point of course leads
onto the further dimensions of risk assessment, the need to address the risk of
harm to self and others. This method of prediction, whilst comprehensively
informed by the static and dynamic assessments covered, lies ultimately with
professional judgment. Again through experience I have become aware of the
impact of certain forms of bias – particularly that of confirmation bias
(Strachan and Tallant 2002) which in relation to MM occurred within the first
point of contact. To counteract this type of bias I learned early on through
assessment that one must utilize all available information, past and present,
and make an objective, informed judgment – which on this occasion set MM’s
level of risk in these two areas to be medium.
The overall assessment
process has been neatly categorized by Smale (1993) who offers three types of
assessment model; questioning, procedural and exchange. It could be argued that
given the dominance of cognitive behaviourist theory through the What Works
movement, the assessment style of the Probation Service could be located within
the questioning model – the practitioner is the expert and the agenda is shaped
to fit the over riding theory. However the emphasis on quantitative measures
and targets (Effective Practice – Chapman and Hough 1998) presents the
possibility that it subscribes to the procedural model whereby the
practitioner, governed by rules and policies, simply collects information. This
would fit coherently with the views expressed by Beaumont (1990), who sees the
impact of managerialism to be pre-occupied with the process of management
rather than the process of actual work with offenders – afterall it is the duty
of managers to carry out policy. I recognise that my assessment of MM could be
located within that of the procedural model – I blindly fought to gather the
relevant information for the PSR and shaped my observations to fit the
prevailing cognitive behavioural hypothesis.
However given my development
of knowledge and practice and utilisation of current approaches I would aim to
assess an offender using the exchange model. This type of assessment sees the
offender more as an expert on their difficulties, or as Lee etal (2003) put it,
‘the client is the assessor.’ Currently
I conduct these types of interview with a focus on the person rather than the
problems, and develop a greater comprehension of the overall situation by
emphasizing problem free talk (Miller & O’Bryne). I also encourage the
offender to identify their preferred futures in detail, which begins to
illustrate their strengths and resources. I am of course still learning with
regards to this solution focused approach, but have found it to be more
agreeable with my own values and beliefs.
Planning
A key aspect of the
supervision process is the formulation of an Initial Supervision Plan (ISP),
which according to NS should be completed within 15 working days of the Order
being imposed. Within the assessment process key considerations for supervision
were highlighted – most notably mental health, alcohol use and discriminatory
attitudes. Furthermore the assessment yielded the completion of a full risk
assessment, and thus the need for a detailed risk management plan – which would
need to be incorporated within the ISP objectives.
In keeping with Chapman and
Hough’s effective practice cycle, it is specified that ‘supervision should follow logically from the assessment made at
pre-sentence or post sentence stage.’ Therefore the plan itself will
incorporate information gathered from the tools utilised within assessment –
The PSR, the Addendum, E-OASys and the SAQ data. At this point I found the
latter tool to be most useful – afterall they were ‘problems’ identified by MM
which he perceived to be linked to his offending. Within the area of planning
there are two important terms I needed to understand. The first was that of
prioritisation – and I have often found myself wondering which problem needed
more attention. For MM I felt that alcohol use and mental health were key, and
given the Court’s need for an addendum aimed at assessing how these issues
could be managed within a community setting, prioritisation on this occasion
was not problematic. The second key term is that of negotiation, specifically
in terms of the goals incorporated within the plan. According to Trotter (1999)
it is ‘important that the tasks,
strategies or solutions developed to achieve the goals are developed by the
client, or at least agreed to by the client.’ Of course I did negotiate
goals with MM – yet I also had my own agenda, which again was encompassed by
the set agenda and expectations of the Service.
When working through this
planning stage I have become aware of the organisations promotion of cognitive
behaviouralism as the dominant theoretical ideology which underpinned practice.
This was highlighted in the PSR I prepared for MM – whereby I found myself
proposing two accredited programmes based upon that very theory. Furthermore I
have been exposed to a variety of manuals (most notably TFEC, which contains
easily implemented exercises), SMARTA objectives (Specific, Measurable, Agreed,
Realistic, Time Limited and Anti-Discriminatory) and the organisations over
riding belief that cognitive behaviourism yields results. If this level of
saturation is not enough then training events and academic modules assisted
further in underpinning the ideologies associated with this theory – yet I have
also been made aware of alternative approaches through the latter. The
prominence of terms such as ‘dysfunctional’ and ‘deficits’ suggest a primary
focus on the problem, yet with MM this often resulted in sessions devoted to
in-depth conversations aiming to locate the causes of such problems. This idea
was highlighted by the goals of the ISP….
- Attend ASRO programme
- Gain independent accommodation
- Increase employability levels
- Explore discriminatory attitudes
- Access support for mental health
Supervising MM was initially
frustrating and when using a task centred approach (my usual strategy) I often
discovered further problems on top of the ones that existed. Therefore in
wishing to achieve these goals I felt that a new approach was needed – and
therefore a move to identifying solutions rather than problems was adopted.
Therefore at this planning stage, and based on past experiences with MM, I felt
that a new take was needed on the current situation, working on the premise
that if MM spent more time looking forward and moving away from his problems,
he may gain some form of relief and tackle them more objectively through this
new approach – Solution Focused Therapy (SFT).
This meant a move away from
my usual work practices, and approaching the planning process in a new light.
An SFT approach has features in common with a task centred approach – it is
largely a cognitive approach and frequently leads to tasks being carried out by
the service user. However whilst the task centred approach focuses on problems,
SFT works on understanding solutions, maintaining that it is not necessary to
understand a problem in order to understand its solution. Therefore its
destination is pinpointed first, and then a line is drawn back to the present
position.
Interventions
The decision to change my
approach in working with MM can be largely attributed to the problem focused
environment we had created and his lack of positive responses to cognitive
behavioural initiatives. Having previously experimented with SFT, and therefore
possessing a baseline knowledge of its effectiveness, I still felt that what I
knew was inadequate, and so decided to undertake further reading before
implementing it as an intervention for MM (Berg 1994, de Shazer 1988, De Jong
and Berg 1998). Reflection within the previous two stages of the cycle suggests
that the concepts of ‘disincentives’ and ‘negatives’ takes precedence within
assessment, whilst in the planning stage the idea of ‘problem’ areas overwhelm
us. However by adopting SFT I had a technique that was pro-social in nature,
yet consistent in promoting a positive self image and self efficacy through
positive reinforcement. For me, and particularly my own set of values, its main
strength is captured by Trotter (1999) in that ‘it puts into practice the idea that people learn best by encouragement
rather than discouragement.’ It is for these reasons that SFT fits well
within my value system, afterall for a person to begin to value and appreciate
others they must first feel valued themselves –
highlighting MM’s weaknesses and constantly exploring problems is not a
feasible way of achieving this.
This change in direction
yielded the initial step of this intervention – the ‘miracle question’ (de Shazer 1988), which looks at what a problem
free future would consist of by asking the client to imagine that they had
awoken to a problem free lifestyle. This allowed MM to take centre stage, he
was the protagonist rather than ‘a
passive recipient of the wisdom of others.’ (Ibid.) Without the enforced
ideals of the service, or indeed myself, MM’s miracle consisted of him owning
his own roofing company, having his own home, relationship, friends and no
worries with regards to alcohol or mental health. It was interesting at this
point to acknowledge that his miracle mirrored what we perceive to be
‘criminogenic needs.’ Traditionally I have sought, as a practitioner, to
establish ‘why’ problems have arisen – yet for SFT it is not necessarily the
‘why’ that matters, but rather how that person is going to move forward. Within
the initial supervision session I discovered that for the first time MM was not
simply talking about his problems – he was eliciting information and
imaginative qualities that had thus far not been evident. Of course his
answering of the miracle question would ‘provide
him with clues on what first steps he needs to take to find solutions, and will
show him how his life will change, thus giving him hope that his life can
change.’ (Berg 1994). At this point I felt that for both MM and myself
there were signs of a move forward – whereas previous interventions had become
stagnant through problem clarification. This renewed approach elicited purpose,
direction, and avoidance of problem talk. However for this intervention to
achieve notable and measurable success I felt that further steps within the SFT
framework needed to be taken.
According to de Jong and
Miller (1998) there are five useful questions that support SFT – of which the
miracle question is but one. A second type is that of ‘scaling questions,’
which Berg (1994) describes as a ‘simple,
versatile and useful tool.’ In this instance clients are asked to express
their feelings about something on a scale emerging from 0 at the low end to 10
at the high end. For MM 10 represented the miracle he had previously described,
and 0 represented life at its worst. Having two such polarized views allowed us
to negotiate what a move up the scale would involve – for example the gaining
of full time employment as a roofer may represent a move from 4 – 5. Initially
MM felt that he could be located at point 2 – and so what this scaling allowed
us to do was set goals that were specific, small and achievable (reminiscent of
SMARTA objectives), whilst at the same time measuring any progress made through
movement within the scale. The need to identify specific goals is an important
aspect of SFT, highlighted by de Shazer’s view that ‘without goals therapists and clients cannot know when the therapy has
succeeded or failed.’ Within these early sessions I also found MM to
display a level of discouragement with his difficulties, and therefore I
occasionally found that I had to adopt a third strand of SFT – the ‘coping
question.’ By asking MM questions such as ‘with all this going on how do you
manage to cope?’ enabled him to draw upon his strengths, remembering how he
used them, and thus refocus on the goals set.
Throughout this alternative
method of communication I myself felt that I was showing more of an interest
not so much in his problems, but in him as a person. For SFT ‘language is the medium through which
personal meaning and understanding are expressed’ (Lee etal 2003), and
therefore it is through conversation that solutions are constructed. As the
intervention has progressed and movement within the scale changed, I have
identified three different types of conversation with MM, which are consistent
with the findings of Gergen and Gergen (1986). For them the three types of
conversation identified were ‘progressive,
stable and digressive narratives.’
Ultimately the purpose of
each session is to ‘assess change and
maintain it so that a solution can be achieved’ (Lipchick and de Shazer
1985), and therefore I feel that it is important, perhaps more so with MM, to
use compliments and positive feedback whenever possible. According to George
(1990) finding strengths to compliment ‘can
help reverse the negative attitudes and begin to build up the client’s idea
that they really can change things.’ It is therefore important to use these
ideas not in isolation, but collectively, and as an ongoing process that forms
a specific intervention, and although at times I felt that I was a little
unsure as to what I was doing, I recalled that positive change was occurring
all of the time, and to facilitate and measure these changes with MM I had to
retain the key principles of SFT.
Evaluation
Ongoing evaluation has been identified as a key element of the effective practice cycle as it allows both the practitioner and the offender to gain a sense of progress and development. Within the context of What Works evaluation methods are a key element of evidence based practice – it allows resources to be reviewed, targets to be achieved and risk to be managed appropriately. For McGuire (1996) evaluation is an ‘assessment of the impact of a service against previously defined criteria or goals.’ In order of achieving the aim of consistent evaluation I have recorded information on the contact sheets after each supervision session of MM, and linked the areas covered with the objectives not only of the Supervision Plan, but also the Risk Management Plan – all in line with NS 2005. However the key to evaluating MM’s progress in relation this specific intervention are three fold. The first aspect would rely on his achievement of the goals set within the planning stage of the cycle. The second key area would be his responses to the specific intervention, most notably his progress over a review period in relation to the scaling process, whilst the last stage would simply be the avoidance of further re-offending.
For Kazi (2001) ‘in some cases it may be possible to obtain baseline measurement before the intervention commences and/or after the intervention has ended, enabling comparisons between the baseline, intervention and/or follow up phases.’ With regards to my practice re-scaling and returning to the miracle were systematic occurrences – which essentially allows for effective evaluation when using a single case design. Therefore upon evaluation I found that whilst MM had taken many positive steps towards his miracle, he had in fact only moved up two points on his scale over the intervention period. However the real progress for this intervention can be measured between the points, that is the sub goals that were set that allowed him to move from say point 2 to 2.5. This can be demonstrated by MM’s referral to an employment agency and his gathering of application forms from nearby factories – and whilst these goals may seem small on the surface they were extremely important for MM not just in terms of employability – but perhaps more importantly in terms of his self esteem and confidence.
What must be highlighted at this point is that this specific intervention was a change in direction and the adoption of a new approach by myself. When reflecting and thus being self critical around my practice it is interesting to note that Milner and O’Bryne (1998) warn against a change of emphasis, as there is a danger of solution focused work being a ‘quick fix.’ This is something that I wish to explore further, yet due to the confines of this essay I cannot. When reflecting on this point, particularly within the evaluation stage, I feel that the positive results achieved reflect the fact that yes it has been successful. However I see this ‘fix’ to be a long term goal, particularly in relation to his employability and self esteem, which form part of MM’s miracle. Of course evaluation is also about being critical of ones own practice, and when I look back and reflect there are aspects of my practice that I do wish to improve/change when using SFT in the future – and making sure that I don’t see SFT as a quick fix is certainly one idea I will retain.
For Chapman and Hough (1998) evaluation is ‘finding out whether the programme is achieving its objectives.’ Whilst this is important to SFT and my specific intervention it does not really tell the whole story. For me evaluation examines our effectiveness and can help us to improve the types of intervention we adopt, it increases our accountability to users and clients, and further develops our own knowledge. It is not simply an end product, but rather an ongoing process that is dynamic in nature. When reflecting on the use of SFT I feel that, whilst not fully deserting cognitive behavioural theory, but rather working within the realms of it, I have broadened my skills and knowledge as a practitioner. This approach, for me, cannot be used in a blanket fashion (Gorman (2001) – ‘one size fits all’), but it can be utilized effectively in certain situations in which one feels it may facilitate change more effectively. Whilst I have attempted to use it previously this is the first time I have felt that I have effectively applied it as a specific intervention, and over a specific period that allows me to evaluate its effectiveness. Of course on this occasion I felt the intervention to have positive connotations, yet I am well aware that on other occasions it may not be quite so effective – and as I develop as a practitioner I will no doubt discover further alternative methods that can be implemented within specific interventions.
In conclusion the effective practice cycle is, in theory, a process that can be followed and understood by all practitioners. However in practice there are many issues that can dramatically change how an offender and a practitioner move through this cycle. In this essay I have discovered for example, that there are many forms of bias that exist, which in turn can alter the outcome of an assessment, which highlight the many issues surrounding anti-discriminatory practice. Indeed I have even practiced under the umbrella of some bias types – and hope to rectify this within my future practice. Still in the assessment stage – I have discovered that I have assessed individuals primarily on their deficits and have not given enough credence to strengths – again something I would like to change and certainly since the production of this essay I have been conscious of throughout my current assessments. Lastly perhaps my most important learning point comes from the person who underpins the intervention I have used, de Shazer. For him ‘the problem is the problem – not the person.’ Holistically I have demonstrated how I have applied a specific intervention within the framework of the effective practice cycle – yet I have become more aware of the multi faceted dimensions that can affect the outcomes of each of the four stages of the effective practice cycle – and ultimately the life chances of the offender.
References…
Chapman, T. & Hough, M. (1998)
Evidence based Practice – A Guide to Effective Practice
London: Home Office
De Shazer, S. (1988)
Investigating solutions in brief therapy
New York: Norton
Egan, G. (2002)
The Skilled Helper
London: Brooks/Cole
George, E., Iveson, C. & Ratner, H. (1990)
Problem to Solution
London: BT Press
Gorman, K. (2001)
Cognitive Behaviourism & the Holy Grail
Probation Journal 48 (1). Pp. 3-9
Home Office (2005)
National Standards
London: Home Office
Kazi, M. (2000)
Contemporary Perspectives in the Evaluation of Practice
British Journal of Social Work. Vol 30 Pp. 755 - 768
Kemshall, H. (1996)
Good Practice in Risk Assessment and Risk Management
London: Jessica Kingsley Publishers
McGuire, J. (1996)
What Works: Reducing Re-Offending
Chichester: Wiley
Milner, J. & O’Bryne, P. (1998)
Assessment in Social Work
London: Palgrave
NPS (2001)
A New Choreography
London:
Parton, N. & O’Bryne, P. (2000)
Constructive Social Work: towards new practice
Basingstoke: Palgrave
Smale, G. & Tuson, G. (1993)
Negotiating Care in the Community
London: HMSO
Strachan, R. & Tallant, C. (2002)
Improving Judgement and Appreciating Biases within the Risk Assessment Process
In….
Kemshall, H. & Pritchard, J. (2002)
Good Practice in Risk Assessment and Risk Management
Trotter, C. (1999)
Working with Involuntary Clients
London: Sage
Tuddenham, R. (2000)
Beyond Defensible Decision Making
Probation Journal Vol 47 (3) Pp. 173-183.
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